Individual
DIVINE TAKO EBAI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
614 ETHAN ALLEN AVE, TAKOMA PARK, MD 20912-5400
(240) 458-8832
Mailing address
614 ETHAN ALLEN AVE, TAKOMA PARK, MD 20912-5400
(240) 458-8832
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
06/11/2026
Last updated
06/11/2026
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